MedicaidCoverageMedium impact
Provider Announcement
Oregon Health Plan·OR · Dentistry, Pediatrics·Plan
Effective date
Jan 1, 2020
We identified it
Jun 20, 2026
Summary
Oregon Health Authority (OHA) is opening 15 dental procedure codes for fee-for-service Medicaid payment effective January 1, 2020. These codes cover space maintainer management, orthodontic appliance repairs, retainer services, and dental case management for patients with special health care needs. Billing teams must update their systems to recognize these newly covered codes and begin billing OHA for eligible Oregon Health Plan members not enrolled in coordinated care organizations.
Action Required
By January 1, 2020: Billing team must update billing software to recognize the 15 newly covered dental codes (D1551, D1552, D1553, D1556, D1557, D1558, D8696, D8697, D8698, D8699, D8701, D8702, D8703, D8704, D9997) as covered services under Oregon Medicaid fee-for-service. Begin billing OHA for these services when provided to Oregon Health Plan members not enrolled in coordinated care organizations. Concurrently, providers should review the Prioritized List of Health Services and Guideline Note 34 regarding extraction codes D7220, D7230, D7240, D7241, and D7250 to ensure extractions are medically/dentally necessary (not for normal eruption pain or non-specific symptoms like headaches). Update encounter forms and provider education materials to reflect the new covered codes. Contact Kellie Skenandore at kellie.m.skenandore@dhsoha.state.or.us or 503-947-5530 with questions.